Publications by authors named "Seung-Min Youn"

6 Publications

  • Page 1 of 1

Non-tendinous healing after repairing of retracted rotator cuff tear- An Imaging Study.

J Shoulder Elbow Surg 2021 May 5. Epub 2021 May 5.

Department of Orthopaedic Surgery, Myongji Hospital, 697-24 Hwajung-dong, Deokyang-gu, Goyang-si, Gyeonggi-do 412-270, Republic of Korea.

Background: Follow-up magnetic resonance imaging (MRI) after rotator cuff repair can sometimes demonstrate healing with non-tendinous tissue that extends from the footprint to the retracted tendon end, which is inferred as fibrous tissue formation. The aim was to investigate this particular finding and its significance.

Methods: There were 494 eligible cases of healed superior medium- to massive-sized rotator cuff repairs, after the exclusion of re-tears. A retrospective review was performed for the three groups that were divided according to their MRI appearances of healing: Type I described the direct 'healing' of the tendon to the footprint, while Types II demonstrated the distinctive continuity of non-tendinous tissue from the footprint to the retracted tendinous portion, and the Type III also showed the similar appearance but with obvious thinning of the tissue, without any evidence of defect confirmed on the routine outpatient ultrasonography.

Results: Only 108 of 494 patients (21.9%) demonstrated Type I healing while the signs of 'non-tendinous' healing were evident for the rest, with the 116 patients (23.5%) being classified as Type III with attenuation. Comparing the preoperative tendon retraction, 34.8% and 37.2% of the Patte stages 2 and 3, respectively, resulted in Type III healing, which were significantly higher compared to that of the stage 1 (15.3%, P<0.001). The Type III had the highest average preoperative Goutallier grades. The average postoperative VAS and the ASES scores have improved significantly for all three groups (P<0.05), with the ASES being 86.1±15.9 for Type I, 93.7±36.1 for Type 2, and 87.8±15.1 for Type 3 without significant differences between the groups (P=0.03).

Conclusions: Only a fifth of the rotator cuff repairs led to the direct 'healing' to the footprint, and the rest healed with the MRI appearances of non-tendinous tissue formation bridging between the retracted tendinous portions and the footprints. These MRI appearances did not represent the true tendinous tissue formation between the torn end of the tendon and the bone after healing. Such appearances did not seem to affect the clinical outcomes.

Level Of Evidence: Level IV; Case Series; Treatment Study.
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May 2021

Biceps Rerouting for Semirigid Large-to-Massive Rotator Cuff Tears.

Arthroscopy 2021 Apr 20. Epub 2021 Apr 20.

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea. Electronic address:

Purpose: To compare clinical and radiographic results of arthroscopic rotator cuff repair (ARCR) with biceps rerouting (BR) and those of conventional repair for semirigid, large-to-massive rotator cuff tear.

Methods: We prospectively collected data of 111 patients who underwent either ARCR + BR (n = 59, group 1) or only ARCR (n = 52, group 2) for semirigid, large-to-massive rotator cuff tear between January 2016 and December 2018. We comparatively analyzed both groups with respect to preoperative factors including concomitant lesions of the long head of the biceps tendon (LHBT). Univariate logistic regression analysis was performed to identify predictive variables for occurrence of retear after ARCR + BR.

Results: Mean age of groups 1 and 2 were 62.8 and 63.7 years, respectively (P = .484). Mean follow-up period in groups 1 and 2 were 15.1 and 25.1 months, respectively (P = .102). Mean range of motion and functional scores improved significantly (P < .05) and comparably (P > .05) in both groups. In total, 11 (18.6%) and 25 (48.1%) patients from groups 1 and 2, respectively, showed retear of the repaired rotator cuff at final follow-up (P < .01). Of 45 group 1 patients who showed less than 50% partial tearing of the LHBT preoperatively, 6 (13.3%) experienced retear. Comparatively, of 14 patients with partial tearing involving more than 50% of the LHBT, 5 (35.7%) suffered postoperative retear. If the patients had partial tear involving more than 50% of LHBT preoperatively, the odds ratio (OR) to have retear was 4.222 (P = .037). Wider (OR, 1.445, P = .047) and thinner (OR, 0.166, P = .019) LHBT were the prognostic factors to have retear. Three (5.1%) group 1 patients showed the Popeye deformity at final follow-up.

Conclusions: ARCR + BR for semirigid, large-to-massive rotator cuff tears effectively improved clinical and structural outcomes as also shown in the conventional repairs. However, the retear rate was significantly lower in patients who underwent ARCR + BR than those treated conventionally. Partial tearing involving more than 50% of the LHBT and wide and/or thin tendon morphology were significant risk factors for postoperative occurrence of retear.

Level Of Evidence: Level III, retrospective therapeutic comparative trial.
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April 2021

Effects of comorbidities on the outcomes of manipulation under anesthesia for primary stiff shoulder.

J Shoulder Elbow Surg 2021 Mar 11. Epub 2021 Mar 11.

Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea. Electronic address:

Background: Studies on the effects of manipulation under anesthesia (MUA) for primary stiff shoulder when different comorbidities are present are lacking. Our aim was to assess how comorbidities influence the recovery speed and clinical outcomes after MUA.

Methods: Between April 2013 and September 2018, 281 consecutive primary stiff shoulders in the frozen phase treated with MUA were included in this study. We investigated the comorbidities of patients and divided them into the control (n = 203), diabetes mellitus (DM) (n = 32), hyperlipidemia (n = 26), and thyroid disorder (n = 20) groups. The range of motion (ROM) and clinical scores for each group before MUA and 1 week, 6 weeks, and 3 months after MUA were comparatively analyzed. We identified the ROM recovery time after MUA and the responsiveness to MUA. Then, subjects were subdivided into early and late recovery groups based on their recovery time and into successful and nonsuccessful MUA groups based on their responsiveness to MUA.

Results: Significant improvements in ROM and clinical scores at 3 months after MUA were observed in all groups. Significant differences in ROM among the 4 groups were also observed during follow-up (P < .05). The DM group had significantly lower ROM values, even at 3 months after MUA, compared with the control group. The ROM recovery speed after MUA was slowest in the DM group, followed by the thyroid disorder, hyperlipidemia, and control groups. Most (90.6%) of the DM group experienced late recovery. The proportion of nonsuccessful MUA was higher in the DM and thyroid disorder groups than that in the control and hyperlipidemia groups (P = .004). During follow-up, there were no differences among groups regarding the visual analog scale, University of California at Los Angeles shoulder, and Constant scores.

Conclusion: The ROM recovery speed and responsiveness to MUA for primary stiff shoulder were poorer for the DM and thyroid disorder groups than for the control group. In particular, compared with any other disease, outcomes were poorer when the comorbidity was DM. If patients have comorbidities, then they should be informed before MUA that the comorbidity could affect the outcomes of treatment.
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March 2021

Functional and radiologic outcomes of uncemented reverse shoulder arthroplasty in proximal humeral fractures: cementing the humeral component is not necessary.

J Shoulder Elbow Surg 2016 Apr 2;25(4):e83-9. Epub 2015 Dec 2.

Department of Orthopaedic Surgery, North Shore Hospital (Waitemata District Health Board), Auckland, New Zealand.

Background: Our aim was to determine the radiologic and functional outcomes of patients who underwent reverse shoulder arthroplasty (RSA) for proximal humeral fractures and to assess whether the uncemented humeral components put them at risk for early loosening and failure.

Methods: Thirty-three patients were identified in our hospital database (January 2004-December 2012). Twenty patients were assessed using American Shoulder Elbow Surgeons (ASES) score, Constant Shoulder Score (CSS), and the Oxford Shoulder Score (OSS). Up-to-date shoulder radiographs were evaluated for evidence of radiologic loosening.

Results: The mean follow-up period was 3.0 years (range, 2.5-7.8 years), and the mean age at the time of surgery was 76.5 years (range, 62-87 years). The mean ASES was 75.9 of 100 (range, 55-98.3), with a mean visual analog scale pain score of 2 of 10. The mean OSS was 42.5 of 48 (range, 35-48), and the mean CSS was 54.1 of 100 (range, 32-72). Upon radiographic assessment of the humeral component, 6 patients (30%) had 3 or more lucent zones, and 12 patients (60%) had a lucent zone measuring more than 2 mm in width; however, only 2 patients (10%) had 3 or more lucent zones measuring 2 mm or more in width and were identified as "at risk of loosening." No patients had tilt or subsidence of the humeral prosthesis.

Conclusions: Our study demonstrated satisfactory functional and radiologic outcomes of patients compared with other studies, suggesting that RSA is a good management option for elderly patients with these fractures. The uncemented nature of the humeral component did not result in early loosening or failure.
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April 2016

The superomedial bare area of the costal scapula surface: a possible cause of snapping scapula syndrome.

Surg Radiol Anat 2013 Mar 9;35(2):95-8. Epub 2012 Aug 9.

Department of Orthopaedic Surgery, Auckland City Hospital, Private Bag 92024, Auckland Mail Centre, Auckland, 1142, New Zealand.

Purpose: Scapulothoracic bursitis is a painful condition of the scapulothoracic articulation, which may be caused by various pathological anatomical associations. We have arthroscopically observed a constant bare area of bone on the costal scapula surface in patients with scapulothoracic bursitis, contradictory to traditional anatomical reports of scapular muscle relations. We undertook a cadaveric study to further define this anatomical feature.

Methods: Twelve cadaveric shoulders were dissected. The costal surface of the scapula was systematically examined for the presence of a superomedial bare area in each shoulder by three independent clinicians, with dimensions measured using digital calipers.

Results: In all shoulders, there was a clearly defined bare area of bone on the superomedial aspect of the costal surface of the scapula between the serratus anterior insertion and subscapularis origin. The bare area was typically crescenteric in shape, with variable length (mean 22.3 ± 6.0 mm) and width (10.8 ± 2.8 mm). The bare area length (p = 0.043) and width (p = 0.033) were significantly greater in female shoulders compared to male shoulders.

Conclusions: We have established the presence of the superomedial bare area of the costal scapula surface. With an absence of overlying subscapularis muscle, this bare area carries the potential for scapulothoracic impingement, and should be considered as a possible aetiological factor in all patients presenting with scapulothoracic bursitis.
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March 2013

Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures.

J Shoulder Elbow Surg 2013 Jan 29;22(1):32-7. Epub 2012 May 29.

Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.

Background: Complex acute proximal humeral fractures may require prosthetic replacement of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been suggested as an alternative to hemiarthroplasty in the management of such fractures. This study compared the functional outcomes of RSA with hemiarthroplasty in patients with acute proximal humeral fractures.

Materials And Methods: All patients who underwent RSA or shoulder hemiarthroplasty for acute proximal humeral fractures between January 1, 1999, and December 31, 2010 were identified from The New Zealand Joint Registry. Baseline information, operative characteristics, and postoperative outcomes (Oxford Shoulder Score [OSS] at 6 months and 5 years, revision rate, and mortality rate) were examined and compared between the study groups.

Results: During the study period, 55 patients underwent RSA and 313 underwent shoulder hemiarthroplasty for acute proximal humeral fractures. Compared with hemiarthroplasty patients, RSA patients were significantly older (mean age, 79.6 vs 71.9 years; P < .001) and more often women (93% vs 78%, P = .013). The 6-month OSS was 28.1 for RSA and 27.9 for hemiarthroplasty, which was not significantly different (P = .923); however, the RSA group had a significantly better 5-year OSS than the hemiarthroplasty group (41.5 vs 32.3; P = .022). There was no significant difference between the RSA and hemiarthroplasty groups in revision rate per 100 component-years (1.7 vs 1.1; P = .747) or in 1-year mortality (3.5% vs 3.6%; P > .99).

Conclusions: Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.
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January 2013